<?php
/* @var $this RefractionOdController */
/* @var $model RefractionOd */
/* @var $form CActiveForm */
?>

<div class="form">

<?php $form=$this->beginWidget('CActiveForm', array(
	'id'=>'refraction-od-form',
	'enableAjaxValidation'=>false,
)); ?>

	<p class="note">Fields with <span class="required">*</span> are required.</p>

	<?php echo $form->errorSummary($model); ?>

	<div class="row">
		<?php echo $form->labelEx($model,'ar_sph'); ?>
		<?php echo $form->textField($model,'ar_sph',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'ar_sph'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'ar_cyl'); ?>
		<?php echo $form->textField($model,'ar_cyl',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'ar_cyl'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'ar_axis'); ?>
		<?php echo $form->textField($model,'ar_axis',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'ar_axis'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'manifest_sph'); ?>
		<?php echo $form->textField($model,'manifest_sph',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'manifest_sph'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'manifest_cyl'); ?>
		<?php echo $form->textField($model,'manifest_cyl',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'manifest_cyl'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'manifest_axis'); ?>
		<?php echo $form->textField($model,'manifest_axis',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'manifest_axis'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'cyrefraction_sph'); ?>
		<?php echo $form->textField($model,'cyrefraction_sph',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'cyrefraction_sph'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'cyrefraction_cyl'); ?>
		<?php echo $form->textField($model,'cyrefraction_cyl',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'cyrefraction_cyl'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'cyrefractionaxis'); ?>
		<?php echo $form->textField($model,'cyrefractionaxis',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'cyrefractionaxis'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'overrefraction_sph'); ?>
		<?php echo $form->textField($model,'overrefraction_sph',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'overrefraction_sph'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'overrefraction_cyl'); ?>
		<?php echo $form->textField($model,'overrefraction_cyl',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'overrefraction_cyl'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'overrefraction_axis'); ?>
		<?php echo $form->textField($model,'overrefraction_axis',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'overrefraction_axis'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'w_sph'); ?>
		<?php echo $form->textField($model,'w_sph',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'w_sph'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'w_cyl'); ?>
		<?php echo $form->textField($model,'w_cyl',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'w_cyl'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'w_axis'); ?>
		<?php echo $form->textField($model,'w_axis',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'w_axis'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'rx_id'); ?>
		<?php echo $form->textField($model,'rx_id'); ?>
		<?php echo $form->error($model,'rx_id'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'personalinfo_id'); ?>
		<?php echo $form->textField($model,'personalinfo_id'); ?>
		<?php echo $form->error($model,'personalinfo_id'); ?>
	</div>

	<div class="row buttons">
		<?php echo CHtml::submitButton($model->isNewRecord ? 'Create' : 'Save'); ?>
	</div>

<?php $this->endWidget(); ?>

</div><!-- form -->